Provider Demographics
NPI:1073287652
Name:ANDREASEN, MARY E (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:ANDREASEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9176 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4626
Mailing Address - Country:US
Mailing Address - Phone:309-261-0225
Mailing Address - Fax:
Practice Address - Street 1:9176 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-4626
Practice Address - Country:US
Practice Address - Phone:309-261-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty